Antimicrobial Resistance in Salmonella

Experience of an Infectious Diseases Hospital in Mumbai, India

  • Dr. Jayanthi S Shastri, Waghmare M , Vaidya N , Aigal U , Dash L
Keywords: Antimicrobial resistance, salmonella, ciprofloxacin, minimum inhibitory concentration

Abstract

countries. The last two decades have witnessed the emergence of multidrug- resistant (MDR) salmonella strains. Objectives: To detect antimicrobial resistance among salmonella isolates from EF cases and to
determine the minimum inhibitory concentration (MIC) of ciprofloxacin in nalidixic acid (NA) sensitive/ resistant strains of salmonellae.
Material and Methods: 890 clinically suspected cases of EF were studied at an Infectious diseases hospital in Mumbai between January June 2006. Clot culture was done in bile broth using conventional techniques.
Typical nonlactose fermenting colonies on MacConkey agar were selected and identified by Gram’s stain and conventional biochemical tests. Salmonella species were further confirmed by slide agglutination test
using polyvalent and factor sera (Denka seiken, Japan). Antimicrobial susceptibility testing was done by Kirby-Bauer disk diffusion method in accordance with the CLSI guidelines and interpretative criteria.
Results: Fifty salmonella isolates from 890 suspected cases of EF (5.6%), comprised of Salmonella typhi (28;56%) and Salmonella paratyphi A (22;44%). All the isolates were sensitive to ciprofloxacin. The 49 (98%)
NA-resistant strains had raised MIC of ciprofloxacin. Analysis of 5-year data revealed increasing resistance to NA, increasing sensitivity to chloramphenicol with ciprofloxacin sensitivity constant at 100%.
Conclusions: Recognition of a distinct subset of EF salmonellae having low-level resistance to ciprofloxacin is important for proper patient management in these cases. Vigilance for the emergence of ciprofloxacin or
ceftriaxone-resistant strains is recommended. 

References

1. Crump JA, Mintz ED. Global trends in Typhoid and Paratyphoid Fever. Clin Infect Dis 2010;50:241-6. DOI:10.1086/649541
2. Sekar U, Srikanth P, Kindo AJ, Babu VP, Ramasubramanian V. Increase in minimum inhibitory concentration to quinolones and ceftriaxone in salmonellae causing enteric fever. J Commun Dis 2003;35(3):162-9.
3. Threlfall EJ, Skinner JA, Ward LR. Detection of decreased in vitro susceptibility to ciprofloxacin in Salmonella enterica serotypes Typhi and Paratyphi A. J Antimicrob Chemother 2001;48:740-1.
4. Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing; 16th informational supplement. Wayne, PA, USA. 2006;M100-S16, vol.26, no 1.
5. Threlfall EJ, Ward LR. Decreased susceptibility to ciprofloxacin in Salmonella enterica serotype Typhi. Emerg Infect Dis 2001;7:448-50.
6. Topley WWC, Balows A, Duerden BI. Topley & Wilson’s Microbiology & Microbial Infections. 9th ed. Arnold Publications. 1998;2.
7. Barry J, Brown A, Ensor V, Lakhani U, Petts D, Warren C, et al. Comparative evaluation of the VITEK 2 Advanced Expert System (AES) in five UK hospitals. J Antimicrobial Chemother 2003;51:1191–1202.
8. Lathi N, Sudarsana J. Changing Sensitivity Pattern of Salmonella typhi in Calicut. Calicut Med Journal 2004;2(1):e2 URL:http://www.calicutmedicaljournal. org/2004/2/1/e2/index.html
9. Khanal B, Sharma SK, Bhattacharya SK, Bhattarai NR, Deb M, Kanungo R. Antimicrobial Susceptibility Patterns of Salmonella enterica Serotype Typhi in Eastern Nepal. J Health Popul Nutr 2007;25(1):82-7.
10. Capoor MR , Nair D, Hasan AS, Aggarwal P, Gupta B. Typhoid fever: narrowing therapeutic options in India. The Southeast Asian Journal of Trop Med and Public Health 2006;37(6):1170-4.
11. Harish BN, Madhulika U, Parija SC (2004) Isolated high-level ciprofloxacin resistance in Salmonella enterica subsp. enterica serotype Paratyphi A. J Med Microbiol 53:819.
12. Raveendran R, Wattal C, Sharma A, Oberoi JK, Prasad KJ, Datta S. High level ciprofloxacin resistance in Salmonella enterica isolated from blood. Indian J Med Microbiol 2008;26(1):50-3.
13. Bhattacharya SS, Dash U. A sudden rise in occurrence of Salmonella paratyphi A infection in Rourkela, Orissa. Indian J Med Microbiol 2007;25:78-79.
14. Mendiratta DK, Deotale V, Thamke D, Narang R, Narang P. Enteric fever due to S. Paratyphi A: an emerging problem. Indian J Med Microbiol 2004;22(3):196.
15. Gupta V, Kaur J, Chander J. An increase in enteric fever cases due to Salmonella Paratyphi A in & around Chandigarh. Indian J Med Res 2009;129:95-98.
16. Rodrigues C, Shenai S, Mehta A. Enteric Fever in Mumbai, India: The Good News and the Bad News. CID 2003;36:535.
17. Ray P, Sharma J, Marak RSK, Garg RK. Predictive efficacy of nalidixic acid resistance as a marker of fluoroquinolone resistance in Salmonella enterica var Typhi. Indian J Med Res 2006;124:105-8.
18. Slinger R, Desjardins M, McCarthy AE, Ramotar K, Jessamine P, Guibord C, Toye B. Suboptimal clinical response to ciprofloxacin in patients with enteric fever due to Salmonella spp. with reduced fluoroquinolone
susceptibility: a case series. BMC Infect Dis 2004;4:36-9.
19. Walia M, Gaind R, Mehta R, Paul P, Aggarwal P, Kalaivani M. Current perspectives of enteric fever: a hospital-based study from India. Ann Trop Paediatr 2005;25:161-74.
20. Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing; 22nd informational supplement. Wayne, PA, USA. 2012;M100-S22, vol.32, no 3.
Published
2019-09-26
How to Cite
Dr. Jayanthi S Shastri, Waghmare M , Vaidya N , Aigal U , Dash L. (2019). Antimicrobial Resistance in Salmonella. The Indian Practitioner, 67(4), 224-228. Retrieved from https://articles.theindianpractitioner.com/index.php/tip/article/view/843